Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Lobbying for a toenail cutting service has been pushed back to the top of the agenda by the Merton Association of Pensioners.
Chairman of the Merton Association of Pensioners (MAP) Jim McKinnon has called for Sutton and Merton PCT to hire more chiropodists so that older or more immobile people can get help keeping their toenails trim.
He said: "In Merton and Sutton there are only 20 chiropodists for 35,000 people. This is a scandal and the only way you can access chiropody is if you have a chronic problem.
"What many elderly people want is a nail cutting service and it is our hope that this can be achieved through MAP."
So what happens when a patient is in for long term hospital care? Do all the patients end up looking like scarecrows? Elderly eye brows need cutting too and someday even Davohorns ears will sprout hair. This is called social care and something that is given such little consideration amongst we Podiatrists.
I salute the GP that realised his patient needed a hair do to boost his/her well being. Far, far cheaper and more morally appropriate than a bag full of drugs and a reasoned approach to the next consultation with this patient when he/she returns for a set at the GP's.
I look forward to the day in 2007 when all these high powered specialist Podiatrists are called to the Geriatric ward to deal with an influx of 10" long gryphotic nails due to the Nailcare policy of 2005. Will you remember how to treat them?
I was told this morning by one of my 91yr. olds. that her 96yr. old friend in the day club gets up in the club regularly and does high kicks just to upset the rest of them!
She says the NHS. Clinic Podiatrists she goes to at her doctors clinic says she has the best feet they have ever seen!
She gets her appointments by her daughter phoning up. She is taken in and is out in ten minute's after having her perfect nails cut!
Where is the assessment and DIY training for nail cutting up here then?
By the way her house I am reliably informed is worth Half a million!
Could my dear patient be exaggerating I wonder?
It is possible that the GP is funding the Podiatric care of his over 80 patients already.
It is possible that the NHS Podiatry dept in your domicile has yet to implement a nail cutting policy.
It is possible that the NHS dept has a nail cutting clinic especially for the over 90's. Local social care policies can appply.
No NHs patient is assessed, as yet, on their means to pay so I hope that your patient's friend continues to enjoy her high kicking life in her half a million house.
As far as I am concerned social care has a valid role in a modern NHS and if a GP chooses to divert funds, within a patient led NHS, to access these resources for a valid reason (evidence based!) then he/she will be serving his patient base to the best.
I believe you have hit the nail on the head with that last comment. This Doctor's Clinic is the only one here which stands out as not running a wait and see appointment list. They are not applying the NHS. DIY. advice approach either! Always puzzled but not really my business! Happy Patients the result!
PS. Some advice from the Hospital Clinic is being given, but that could be age related too?
If a GP decides to provide an all encompassing service to all pensioners then he could do this.
I have no problem with this .
I would love to know who is not getting what in order to fund this level of care.
In my area we have a population of 125k this is a retirement area and has a high level of elderly in the area anyway.
So lets say 25% are over 65 this means that there are approx 30k residents over 65 who will want nail care.
4 appts a year is 120k appts p/a
So how can a dept of 6 whole time equivalents attempt to provide this level of care?
My dept at any one time has an active case load of about 4.5k.
This caseload is predominately Diabetes ,Vascular ,Neurological,Wound Care , Rheumatology. Nail Surgery is an important part of our service. There is also Bio Mech via normal access and via the new Orthopaedic Triage Assessment Clinic so we are seeing an increasing no of pts who previously would have been referred to the Orthopaedic Surgeon for an Orthopaedic assessment. There is also the Falls Prevention Service who refer for Insole Therapy . There is also the Admission Prevention Service where Ill At risk ;people are referred to us for a variety of things to try and keep them in their home and mobile.
Soon we will have the CHRONIC ILLNESS Healthcare Management this is for YOUNG BABIES THROUGH TO END OF LIFE and everybody in between who has a chronic healthcare need.
So from all of the above providing simple nail care to fit pensioners is a definite NO GO>
We are now looking at setting up a Nail Cutting service via Carers, relatives, Nurses, Voluntary Sector eg Age Concern and Help The Aged. I find it funny that Private Practice is never considered as an option even though they are the best option. But hey only Consultants should have private practices off the back of NHS failings.
So a definite no to nail care.
In all honesty we have not had a single referal back to us as a result of a complication of not providing a nail cutting service.
Anybody here implemented Nail cutting education to a variety groups. If so any info on how this was done would be most gratefully received.
Again i look to the dental model.
I am an NHS pt but i still pay fees.
So why can i not have the opportunity to be as rich as my NHS dentist.?
The issue of toe nail cutting in the NHS is a fraught with difficulties. In 23 years in the NHS I have only experienced 10-20 people who wanted their toenails cut because they were entitled but had no pathological nail conditions.
The vast majority are referred from GP and nursing colleagues because the pt has a problem such as severe onychogryphosis, severe involution, onychocryptosis, onychomycosis and onycholysis. Now they as lay people do not realise what condition they may be suffering from and indeed sub ungual ulceration is quite common in a lot of elderly patients with O/G.
So do you allow reception staff quoting some policy document to refuse the person an appointment, treatment or assessment or do you assess, advise, treat and discharge where appropriate?
Where do you discharge them to? There is very little voluntary sector nail cutting going on and what level of instrument sterilisation occurs at these voluntary services?
Should then they go private? Possibly but we cannot refuse to first assess them and then being the canny individuals patients can be, when they need further services the local GP can be asked to refer for another assessment.
GP gets annoyed at being pestered by the same pt and gets annoyed at NHS podiatry service for wasting their time asking for new referrals all the time! I agree with other contributors that we haven't the resources to manage long term care of chronic toenail conditions or the nail care of patients with diabetes assessed with low risk feet.
Now personally I feel uncomfortable with the policy some podiatry depts have adopted which is "we will only treat the parts of the foot with the problem and not anything else" this sounds great but only leads to pt going completely "private" (which is perhaps the idea of the scheme!).
This system would mean an NHS appointment for the R/1 O/G and L/4 MTP pl HD as an example but the other nails the patient cannot reach not being treated at all and the pt then has to seek alternative "private?" arrangements, so if the pt has to pay for some "bits" of their feet then logically they may as well save time and let the private practitioner do it all.
I do not claim to have any answers but I trained to help people with a foot health need and if we are in the NHS going to say "we are only going to treat the feet of people with severe foot deformities; loss of tissue viability; arterial insuffiency and/or loss of sensation, through neuropathy or some other neurological condition then can we please have a national policy with national publicity, as local policy changes left to be implemented by local staff always leads to pt complaints and then management desperately back pedalling for certain cases who are vocal enough to get a decision reversed.
Any NHS manager willing to take up the mantle? ................No I didn't think so.
The implementation of the new Medicare enhanced care plan for allied health in Australia (18 months into its start ) appears to be triggering the very scenario outlined by Andy Neave. Noble in its aspirations in treating patients with chronic multiple diseases- but could soon swamp the system with basically low risk obese diabetics who simply cannot reach their feet.
Many of the profession view foot care assistants as "stealing " the bulk of their practice, other podiatrists may specialise & never provide palliative care .The cost of equipment and outlays for palliative care meeting full sterilisation standards and a carrying a wide range of appropriate dressings,paddings etc is probably one of the more costly services in terms of fees returned for the service. So those who have greatest clinical consumption needs are greatest in number and (mostly) have least ability to pay a fee commensurate to the cost. This is similar to public transport for low income earners and is the reason we pay taxes - to provide subsidies for essential but costly services! A new tier of personal health carer under our supervision and trained by Schools of Podiatry through TAFE is going to be needed if we are going to label ourselves as primary health specialists of the foot & lower limb at the top of the ttree.
The dentists employ Dental Hygienists to do clean ups on straight forward mouths.